Abstract
BackgroundRecurrence of post-burn contractures, following inadequate management of post-burn contractures (PBC), is under reported. It is associated with multiple operations and an increased cost to patients and their families. The purpose of this study was to determine the frequency of recurrence of PBC of the shoulder and the elbow joint three months after surgical intervention and the associated risk- factors.MethodsThis was a prospective cohort study conducted at CoRSU hospital from March 2012 to November 2014. All patients with PBC of the elbow and/or shoulder joint who consented to be in the study and met the inclusion criteria were enrolled. Data was collected using a pretested, coded questionnaire. A goniometer was used to measure the active range of motion of the involved joint. The measurements were recorded in degrees. The data was analysed with STATA version 12.1.Results58 patients were enrolled consecutively in the study. There were 36 females and 22 males, with a female to male ratio of 1.6:1. The age range was 0.75–45 years, with a median age of 5 years. The average age at the time of injury was 3.4 years. The most common cause of initial burn injury was scalding. The average number of joints involved per patient was two. There was a high incidence of recurrence of PBC (52 %) among the participants. The shoulder had the highest frequency of recurrence at 67 %. The elbow joint had a frequency of recurrence of 27 %. All participants with both elbow and shoulder joint involvement had PBC recur. The risk factors for recurrence were flame burn (p = 0.007), duration of PBC of more than 1 year (p = 0.018), and incomplete release of the contracture (p = 0.002). The presence of keloids, hypertrophic scars, ulcers and the occurrence of complications at the contracture site were not associated with recurrence of PBC.ConclusionRecurrence of PBC of the elbow and shoulder joint is a common problem. The risk factors should be kept in mind during management of PBC to reduce the recurrence rate.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-015-0089-y) contains supplementary material, which is available to authorized users.
Highlights
Recurrence of post-burn contractures, following inadequate management of post-burn contractures (PBC), is under reported
This study was carried out to determine the frequency of recurrence of PBC of the shoulder and elbow joint and the associated risk-factors among patients managed at our centre. Study design This was a prospective study involving all patients who had PBC of the elbow and/or shoulder joint who were managed at Comprehensive Rehabilitation Services Uganda (CoRSU) hospital from 2012 to 2014
97 % of the participants had been treated in a hospital for the initial burn injury. 67 % of the participants had multiple-joint involvements, with the average number of joints involved by PBC being two. 10 % had prior treatment for post-burn contracture having already had recurrence, and of these 4 patients had recurrence at the shoulder joint and two at the elbow joint
Summary
Recurrence of post-burn contractures, following inadequate management of post-burn contractures (PBC), is under reported. Post-burn contractures (PBC) are a distressing problem in both the developed and developing worlds [1,2,3]. They usually occur following inadequate primary burn injury management [4]. Shoulder joint PBC have been reported to be more challenging to manage due to the wide range of motion of the joint. Management of these contractures has been reported to have complications which predispose to recurrences [11].
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